Predisposing factors: Age ( 15-55 years of age) Genetics (history of breast cancer)

Precipitating factors: Hormonal factors Radiation exposure Fat intake and obesity Alcohol use Idiopathic

Infection

Congenital immune defects

Nutrient or other deficienc y

Immuno- deficiency state Immune suppression Reduced anti tumor effectiveness Tumor growth in ductal epithelium Loss of tumor antigens

Tumor invasion in lymphatic vessel

Tumor growth in axilla Tumor growth within internal mammary lymph node Transpectoral tumor growth

Embolization to regional lymph node of axilla

Small mass of cells breaks off from the tumor entering the lymphatic system

Enlargement of lymph node Obstruction of normal lymphatic pathways Spread to the opposite breast Entering to the base of neck Spread to the abdominal cavity

Metastasis from the vertebral vein

Metastasis to the lungs

Small, painless lump in the upper outer quadrant of breast

Metastasis to kidneys Metastasis to liver

Spreading in ovary Growth in adrenal and pituitary glands

Hormonal effects

Tissue destruction

Obstruction of function

Various systemic disorder

Loss of function

ulceration

pain

Decreased blood flow

hemorrhage DEATH Various local disorder

DEATH

Is the leading type of cancer in women.Most breast cancer begins in the lining of the milk ducts, sometimes the lobule. The cancer grows through the wall of the duct and into the fatty tissue. Breast cancer metastasizes most commonly to auxiliary nodes, lung, bone, liver, and the brain. The most significant risk factors for breast cancer are gender (being a woman) and age (growing older). Other probable factors include nulliparity, first child after age 30, late menopause, early menarche, long term estrogen replacement therapy, and benign breast disease. Controversial risk factors include oral contraceptive use, alcohol use, obesity, and increased dietary fat intake. About 90% of breast cancers are due not to heredity, but to genetic abnormalities that happen as a result of the aging process and life in general. A womans risk of breast cancer approximately doubles if she has a first-degree relative (mother, sister, daughter) who has been diagnosed with breast cancer. About 20-30% of women diagnosed with breast cancer have a family history of breast cancer.

STAGES OF BREAST CANCER STAGE DEFINITION Stage 0 Cancer cells remain inside the breast duct, without invasion into normal adjacent breast tissue. Stage I Cancer is 2 centimeters or less and is confined to the breast (lymph nodes are clear). Stage IIA No tumor can be found in the breast, but cancer cells are found in the axillary lymph nodes (the lymph nodes under the arm) OR

Stage IIB

Stage IIIA

Stage IIIB

Stage IIIC

Stage IV

the tumor measures 2 centimeters or smaller and has spread to the axillary lymph nodes OR the tumor is larger than 2 but no larger than 5 centimeters and has not spread to the axillary lymph nodes. The tumor is larger than 2 but no larger than 5 centimeters and has spread to the axillary lymph nodes OR the tumor is larger than 5 centimeters but has not spread to the axillary lymph nodes. No tumor is found in the breast. Cancer is found in axillary lymph nodes that are sticking together or to other structures, or cancer may be found in lymph nodes near the breastbone OR the tumor is any size. Cancer has spread to the axillary lymph nodes, which are sticking together or to other structures, or cancer may be found in lymph nodes near the breastbone. The tumor may be any size and has spread to the chest wall and/or skin of the breast AND may have spread to axillary lymph nodes that are clumped together or sticking to other structures, or cancer may have spread to lymph nodes near the breastbone. Inflammatory breast cancer is considered at least stage IIIB. There may either be no sign of cancer in the breast or a tumor may be any size and may have spread to the chest wall and/or the skin of the breast AND the cancer has spread to lymph nodes either above or below the collarbone AND the cancer may have spread to axillary lymph nodes or to lymph nodes near the breastbone. The cancer has spread or metastasized to other parts of the body.

ASSESSMENT

A firm lump or thickness in breast, usually painless; 50% are located in the upper outer quadrant of the breast. Spontaneous nipple discharge; may be bloody, clear or serous.

Asymmetry of the breast may be noted as the woman changes positions; compare one breast with the other. Nipple retraction or scalliness, especially in Pagets disease. Enlargement of auxiliary or supraclavicular lymph nodes may indicate metastasis.

DIAGNOSTIC EVALUATION

Mammography (most accurate method of detecting non-palpable lesions) shows lesions and cancerous changes, such as microcalcification. Ultrasonography may be used to distinguish cysts from solid masses. Biopsy or aspiration confirms diagnosis and determines the type of breast cancer. Estrogen or progesterone receptor assays, proliferation or S phase study (tumor aggressive), and other test of tumor cells determine appropriate treatment and prognosis. Blood testing detects metastasis; this includes liver function tests to detect liver metastasis and calcium and alkaline phosphatase levels to detect bony metastasis. Chest x-rays, bone scans, or possible brain and chest CT scans detect matastasis.

PHARMACOLOGIC INTERVENTIONS
1. Chemotherapy is the primary used as adjuvant treatment postoperatively ; usually begins 4 weeks after surgery (very stressful for a patient who just finished major surgery). Treatments are given every 3 to 4 weeks for 6 to 9 months. Because the drugs differ in their

2. 3. 4. 5.

mechanisms of action, various combinations are used to treat cancer. Principal breast cancer drugs include cyclosphosphamide, methotrexate, fluorouracil, doxorubicin, and paclitaxel. Additional agents for advanced breast cancer include docetaxel, vinorelbine, mitoxantrone, and fluorouracil. Herceptin is a monoclonal antibody directed against Her-2/neu oncogene; may be effective for

patients who express this gene Indications for chemotherapy include large tumors, positive lymph nodes, premenopausal women, and poor prognostic factors. Chemotheraphy is also used as primary treatment in inflammatory breast cancer and as palliative treatment in metastatic disease or recurrence. Anti-estrogens, such as tamoxifen, are used as adjuvant systemic therapy after surgery. Hormonal agents may be used in advanced disease to induce remissions that last for months to several years.

SURGICAL INTERVENTIONS
1. 2. 3. Surgeries include lumpectomy (breast-preventing procedure), mastectomy (breast removal), and mammoplasty (reconstructive surgery). Endocrine related surgeries to reduce endogenous estrogen as a palliative measure. Bone marrow transplantation may be combined with chemotherapy.

NURSING INTERVENTIONS
1. 2. 3. 4. 5. 6. 7. 8. 9. Monitor for adverse effects of radiation therapy such as fatigue, sore throat, dry cough, nausea, anorexia. Monitor for adverse effects of chemotherapy; bone marrow suppression, nausea and vomiting, alopecia, weight gain or loss, fatigue, stomatitis, anxiety, and depression. Realize that a diagnosis of breast cancer is a devastating emotional shock to the woman. Provide psychological support to the patient throughout the diagnostic and treatment process. Involve the patient in planning and treatment. Describe surgical procedures to alleviate fear. Prepare the patient for the effects of chemotherapy, and plan ahead for alopecia, fatigue. Administer antiemetics prophylactically, as directed, for patients receiving chemotherapy. Administer I.V. fluids and hyperalimentation as indicated. Help patient identify and use support persons or family or community.

10. Suggest to the patient the psychological interventions may be necessary for anxiety, depression, or sexual problems. 11. Teach all women the recommended cancer-screening procedures.

A Brief History of Breast Cancer

Ancient Egyptians first noted and recorded the disease as tumors, or ulcers, of the breasts, concluded that there was no real cure and that the only form of treatment was cauterization with a tool called the "fire drill". Since then, there have been many similar cases described by doctors throughout history that concluded that there was no cure; or really effective treatment. When doctors started to understand the human circulatory system in the seventieth century, they also managed to establish a link between breast cancer and the lymph nodes in the armpits. Between the seventeen and eighteen hundreds, the French surgeon Jean Petit and Scotsman Benjamin Bell were the first ones to remove the lymph nodes, breast tissue and chest muscle in an effort to save woman from breast cancer. The French surgeon Jean Louis Petit (16741750) and later the Scottish surgeon Benjamin Bell (17491806) were the first to remove the lymph nodes, breast tissue, and underlying chest muscle. Their successful work was carried on by William Stewart Halsted who started performing mastectomies in 1882. By the 1880s, William Halsted started performing mastectomies. His procedure became known as the Halsted Radical Mastectomy and it remained a popular procedure in the fight against breast cancer right up to the 1970s. Breast cancer is a cancer of the glandular breast tissue and is found in both male and female patients. Worldwide breast cancer accounts for almost 1% of all deaths, is the fifth most common form of cancer and the most common form found in women. Although breast cancer is the most prevalent cancer in women in the United States, it is only the second most common cause of cancer death in women (after lung cancer). U.S. women have a one in eight lifetime chance of developing invasive breast cancer and an almost 3% chance of breast cancer causing their death. Due to our modern lifestyle the 'experts' claim and have also noted, a significant increase in the number of cases since the 1970s. The breast is composed of identical tissues in males and females. Therefore breast cancer also occurs in males, though it is less common. Although men have a lower risk of developing breast cancer, this risk appears to be

rising. There seems to be an increased incidence of breast cancer in men with prostate cancer. The notable point about male breast cancer is that the prognosis is worse in men than in women and treatment of men with breast cancer is similar to that of the treatment given to older women. Because the male breast tissue is confined to the area directly behind the nipple, treatment for males has usually been a mastectomy. On a more positive note, most breast cancer symptoms do not turn out to represent underlying breast cancer. These normally turn out to be benign diseases of the breast and only represent the more common symptoms similar to breast cancer itself. However, any appearance of new breast symptom should be taken very seriously by patients and doctors; because of the possibility of an underlying breast cancer that can develop at any age. As with all types of cancer, the detection and treatment of breast cancer has a far greater chance of a positive outcome by detecting it earlier rather than later.

Facts about Breast Cancer

Excluding skin cancers, breast cancer is the most regularly detected cancer among women. This cancer forms more than 1 in 4 cancers detected among women in the United States of America. Did you know that 1 woman is detected with this cancer each 3 minutes, and 1 woman will expire of it every 13 minutes in the United States of America. An anticipated 182,460 fresh cases of persistent breast cancer are anticipated to crop up among women in the USA during 2009-10. There is no preclusion. There is no treatment. This cancer knows no limitations of race or rank. Probabilities are, at some stage of your life, someone you love will accept a finding of breast cancer. Even though the majority of women detected with the ailment are over 50, it can hit women of all ages.

The exact origin of this cancer is still unidentified. Many women believe the ailment will by no means envelope them since it doesn't run in their families. The good news is that each year takes us nearer to a cure. Breast cancer treatment has enhanced radically in the past 5 to 10 years.

Breast Cancer Statistics

Breast cancer statistics show that the cancer affects the lives and health of millions worldwide.

Women's cancer stands for just about 60% occurrence among women cancer survivors. This year 211,000 fresh cases of breast cancer are anticipated in the United States of America. 1 out of 7 women who live till the age of 85 years will establish breast cancer throughout her life span. 70% of all breast cancers are discovered through breast selfexaminations. Not all lumps are noticeable by feel. It is suggested you plan usual mammograms and each month breast self-exams. 8 out of 10 lumps are not cancerous. If you find a knob, don't fearget in touch your doctor for an appointment. When breast cancer is diagnosed at a premature stage, the 5-year survival rate is 90%. The good news is that more than 2 million breast cancer survivors are alive in United States of America today.

Although the precise cause of this cancer is still unidentified, there are more than a few factors that can amplify a woman's hazard of counting genetics, premature puberty, delayed childbearing, heaviness. The prime risk factor for breast cancer is age. Existing breast cancer statistics reveal that it crops up more in women above the age of 50, and women over 60 are at the maximum risk.